525 or 580 cc to achieve this look?

Question

Hello! I will be getting a breast augmentation soon considering 525cc or 580cc Silicone Gummy Bear Implants under the muscle. I liked the way the 525 fits but, I’ve heard to go with the bigger size when they will be under the muscle. I really want cleavage but don’t want them to be extremely close together. Also, my doctor said that my breast has naturally bottomed out (BF 2 kids) is that a concern? Will be repairing w a capsulorrhaphy to both breasts. 5’4 117 lbs. Currently a 32A.

Gary M. Horndeski, MD · Answer

You are a thin person and your breasts are too low on the chest wall.  525 cc or 580 cc implants weigh over 1 lb each, your breasts will descend even lower and will most likely bottom out or double bubble.  I strongly suggest you consider an alternative of a breast lift with fat transfers.  Most women do not like lifts because of the ugly vertical scars associated with the traditional techniques.  For that reason, an alternative was developed called The Bellesoma Method.  This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage.  Vertical scars are avoided, nipple sensation and the ability to breast feed are maintained.  At the same time or later, fat transfers can be performed if additional volume is desired.  Implants are not lifetime devices and half are removed by 9.5 years.  Fat transfers are permanent and incorporated into the body. Best Wishes,Gary Horndeski, M.D.

Edwin C. Pound, III, MD · Answer

Based on your pictures, it appears that you have lost volume in the upper portion of your breasts due to child-bearing.  This is called "pseudoptosis" or false sagging of the breasts.  I do not believe that you have "bottoming out."  That is not something that usually happens with child-bearing.  Rather, it is usually associated with breast augmentation surgery where the lower portion of the breast is over-dissected.  I don't think you need a capsulorrhaphy.  I also think your cleavage will improve with the addition of implants alone.  As for the volume needed to achieve the look that you desire, there are lots of choices these days with regards to implant size, type, volume, etc.  This decision needs to be made in consultation with a board-certified plastic surgeon who can examine you in person and review your options with you.

Michele A. Shermak, MD · Answer

Hello!My favorite technique for sizing and prediction of outcome is to try implants on in a bra. Actual results will be smaller when the implants are under your muscle as you say. Volume of implant depends on your chest width and implant fullness you desire. The implant, especially a fuller implant, will better center your nipple and it looks like you may need slightly differently sized implants to get more even match.Best of luck!

John LoMonaco, MD, FACS · Answer

You have a fairly small amount of skin and breast tissue for an implant in the 500cc range, based just on photos but nothing substitutes for an in-person exam and sizing process.Assuming your skin can safely hold a 500cc implant or larger, the question of an extra 70 or 80cc to get you the desired result is going to be up to your surgeon during the procedure.  It's nearly impossible to predict exactly how much the breast tissues and skin will stretch, so it's important to communicate to your surgeon your goals and then trust him or her to accomplish that during surgery.

Daniel Barrett, MD · Answer

Dear lovejanedoe,breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. You are a great candidate for a breast augmentation.  580cc is a large implant.  The size, profile, and shape of the implant is based on your desired breast size/shape, your chest wall measurements, and soft tissue quality.  This decision should be based on a detailed discussion with equal input from both you and your surgeon.   Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results. 
 
 Best wishes and good luck.

Richard G. Reish, M.D. FACS

Harvard-trained plastic surgeon

Richard Rosenblum, MD · Answer

Thank you for your questions and your photos. It is hard to tell from photos which size implant will give you the look you desire. Your best option is to consult with a Plastic Surgeon where you are able to try on the different sizes of implants and have the surgeon provide you with their professional opinion. Good Luck.

Tarek V. Copty, MD, FACS · Answer

Dear Lovejanedoe, 
An in office evaluation will determine the best size and shape of implant to use in order to provide you with the results shown in your desired photographs. Your breasts have lost some fullness in the top due to childbearing however they are not what one considers "bottomed out." This is a term generally reserved when the lower portion of the breast is over dissected during augmentation and drops. If your surgeon understands your desired look then during the surgery different sizers will be used to determine which size provides you the cleavage that you want. This may vary and is hard to determine when just trying on the implants in a consultation room. In my surgical facility I carry a full stock of every size implant so that during the procedure the decision can be made based on the patients desired results. 
I hope this is helpful. Best regards, Tarek V. Copty, MD FACS

Robert L. Kraft, MD, FACS · Answer

It is true that going under the muscle leans toward a larger implant, I would have a concern as to whether 580 cc is too large, especially as your breasts are low on your chest.  Augmentation is not a substitute for lift. If you are borderline for lift, then going too large can bring on its own set of issues.  You are not bottomed out. That term is used to describe a complication of augmentation.

Connie Hiers, MD, FACS · Answer

Thank you for your pictures and questions. Although your pictures are great i can not fully determine what size will be needed.Highly cohesive gel silicone implants seem to maintain their shape better however there are cons to this as well. They cause more prominent scarring, cost more and they can move out of place. As always seek a board certified plastic surgeon that you are comfortable with.

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